Dental Benefit

The Dental Benefit provides coverage for certain oral surgical procedures and courses of treatment following accidental injury. Eligible expenses under the Dental Benefit are the reasonable and customary charges for these services and procedures when performed by a dentist or dental surgeon.

Lower cost alternative

When two or more courses of treatment for oral procedure or accidental injury are considered appropriate, the Plan will pay for the treatment that is least expensive.
If you choose to have the more expensive treatment, the Plan will only reimburse you up to the amount quoted for the less expensive treatment, as long as the treatment you choose is not excluded under the Plan.

Order of claiming

For oral surgery:

If you are covered under the Public Service Dental Care Plan, the Dependants Dental Care Plan, the CF Dependants Dental Care Plan or the Pensioners' Dental Services Plan, you must submit your claims for oral surgery to that plan first. Any amount not covered by your dental plan may then be submitted to the PSHCP.

Accidental injury:

You should submit your claims for accidental injury expenses to the PSHCP first.

Eligible expenses

Expenses for treatment of accidental injury

The Plan covers the services of a dental surgeon and charges for dental prosthesis when required for the treatment of a fractured jaw or accidental injuries to natural teeth if the fracture or injury was caused by an external, violent and accidental injury or blow. The Plan does not cover injuries associated with normal acts such as cleaning, chewing and eating.

Treatment must occur within 12 months following the accident or, in the case of a dependant child under 17 years of age, before attaining 18 years of age.

This time limit may be extended if, as determined by Sun Life, the treatment could not have been rendered within the time frame specified.

A physician's prescription is not required.

Expenses for oral surgical procedures

Procedure category Specific procedure
Cysts, lesions, abscesses

Biopsy

  • soft tissue lesion
  • incision
  • excision
  • hard tissue lesion

Excision of cysts
Excision of benign lesion
Excision of ranula

Incision and drainage

  • intra oral—soft tissue
  • intra osseous (into bone)

Periodontal abscess

  • incision and drainage
Gingival and alveolar procedures

Alveoplasty
Flap approach with curettage
Flap approach with osteoplasty
Flap approach with curettage and osteoplasty
Gingival curettage
Gingivectomy with or without curettage
Gingivoplasty
Removal of teeth or roots

Removal of impacted teeth

Removal of root or foreign body from maxillary antrum

Root resection (apiectomy or apicoectomy)

  • anterior teeth
  • bicuspids
  • molars
Fractures and dislocations

Dislocation—temporomandibular joint (or jaw)

  • closed reduction
  • open reduction

Fractures—mandible

  • no reduction
  • closed reduction
  • open reduction

Fractures—maxillar or malar

  • no reduction
  • closed reduction
  • open reduction
  • open reduction (complicated)
Other procedures

Avulsion of nerve—supra or infra-orbital
Frenectomy—labial or buccal (lip or cheek)
Lingual (tongue)
Repair of antro-oral fistula
Sialolithotomy—simple
Sialolithotomy—complicated
Sulcus deepening, ridge reconstruction

Treatment of traumatic injuries

  • repair of soft tissue lacerations
  • debridement, repair, suturing
Torus (bone biopsy)

 

Exclusions

No benefit is payable for:

  • expenses identified in the General Exclusions and Limitations of the Plan
  • expenses for treatment of accidental injuries to natural teeth and oral surgical procedures other than those identified
  • accidental injuries associated with normal acts such as cleaning, chewing and eating
  • expenses for dental cleaning and maintenance services
  • braces, retainers, headgear and other dental devices